孕婦疫苗接種現況與展望

Prevalence and Prospect of Pregnant Women Vaccination

接種疫苗顯著地降低兒童的傳染性疾病及死亡。不過在嬰幼兒族群，目前疫苗能提供的保護相對缺乏。因此，藉由孕婦疫苗接種，來增加嬰幼兒的抵抗力，減少嬰幼兒時期的感染，是個有效可開發的領域。懷孕期間性荷爾蒙的變化，會改變母親的免疫反應，進而影響疫苗接種的免疫生成性。目前我國傳染病防治諮詢會預防接種組 （ACIP） 建議，孕婦應該優先接種流感及百日咳疫苗，這在許多研究都獲得證實。孕婦接種流感及百日咳疫苗可以有效減少嬰幼兒的嚴重感染及併發症。目前開發中的孕婦疫苗，以呼吸道融合病毒疫苗及 B 型鏈球菌疫苗有最大進展，期待未來能進一步降低早產兒及新生兒的併發症及死亡。將疫苗接種納入常規孕婦產前照護，有許多困難及挑戰，也是兒童疫苗接種的最後一塊拼圖。

Vaccination has significantly reduced the prevalence of pediatric infectiousdiseases and mortality. However, current vaccines offer limited protection to younginfants. Therefore, maternal immunization is a potentially useful tool to increase theimmunity and decrease infection in young infants. During the course of pregnancy,the changing levels of sex hormones induce variable immune responses and furtherinfluence the immunogenicity of vaccines. Recently, the Advisory Committee onImmunization Practices in Taiwan recommended that seasonal influenza vaccinationprograms and adult Tdap immunization programs should give the highest priorityto pregnant women. Several studies confirmed that maternal influenza and Tdapimmunizations significantly decreased the occurrence of severe infection andcomplications in young infants. Maternal vaccines developed against respiratorysyncytial virus and group B streptococcus made the most progress. We expect thatthese vaccines can further decrease the complications and mortality in preterminfants and neonates. Incorporating maternal vaccines into routine antenatal carehas been a challenge. However, it is also the last piece of the puzzle of pediatricimmunization programs.